30 Years – More homeless youth, But few other changes

30 Years – More homeless youth, But few other changes Mary Jane Rotheram-Borus

Declaration of the Rights of the Child UN Document Series Symbol: ST/HR/ UN Issuing Body: Secretariat Centre for Human Rights Proclaimed by General Assembly resolution 1386 (XIV) of 20 November 1959

The numbers of homeless youth are rising over time 1987 2016/17 Los Angeles 12,000 63,000 NYC 12,000 23,110

Youth go to where the services are – Downtown Hollywoood Venice

Homeless shelters are congregated in high risk neighborhoods

Homeless shelters are congregated in high risk neighborhoods: LA Type of sexWhere Gay-for-pay Hollywood Straight –sex-for-pay Sunset Sex-for-drugs Santa Monica

Yet, who, where, & when youth are homeless is clear & consistent over time. Lesbian, gay, bisexual, & transgendered youth Psychiatrically disturbed girls having sex at 12 years Children in foster care Children whose families go homeless Youth with serious mental illness Youth with contact with criminal justice

Problems the same 30 years later, at similar rates 25% attempt suicide 25% sexually abused 27% psychiatrically disordered 40% jail (93% if LGBTY 80% some drug use 40% problems at school 80% boy-girl-boy troubles

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2018, Adolescent Trials Network N= 455

2018 Adolescent Prevention Trials Network N= 168

Over the last 20 years, the numbers of EBI have been substantial & all similar HIV+ Family Miscellaneous HIV- HIV+ Street Smart TALC N.Y. Safety Counts, IDU TLC Street Smart Computer TALC L.A. Promise CLEAR Street Smart Uganda TALC South Africa CPOL China Healthy Living TALC Thailand Project LIGHT Project LIGHT STRIVE SUUBI HIV+ Testing, Churches TALC China Teen LIGHT MD For Life Philani, SA Zithulele, SA ATN, #2 Men’s soccer, SA SMI LIGHT

HIV Interventions # of Sessions Facilitators Site N NYC, LA, Miami, SF TLC Clinic Staff 310 31 NYC, LA, SF CLEAR MA Level 253 18 CBO Staff Kampala, Uganda SUUBI 100 18 HEALTHY LIVING NYC, LA, SF, Wisconsin 15 MA Level 936

Common Life Challenges for PWA Health Transmission Quality of Life Parenting / Family / Relationships

Outcomes Substance Abuse Follow-up, months Sex 45% sex partners 31% weighted use index TLC 50% HIV- sex partners 24 82% unprotected sex 21% alcohol, mar., hard drugs CLEAR 15 59% HIV- sex partners in # sexual partners SUUBI N/A 24 condom use alcohol, mar.,hard drugs,days of use HEALTHY LIVING 53% sex acts with HIV- or unknown status 25

Common Effective Learning Model Same Theory, All Interventions Change occurs … slowly, over time with small steps in supportive relationships with opportunities & rewards

Identified Common Robust Factors in EBI • Selected successful programs • Obtained reliable category definition • Identified common principles & processes • Validated principles, re-review

Common Processes Behavior & cognitive focus Structural activities Goals Cohesiveness

Common Rules • Be prepared • Have + alternatives • Make explicit plans • Judge on facts • Practice self-control

Common Factors in Interventions Feel/Think/Do Skills Health-Specific Information Frame Issue Supportive Relationships Environmental Barriers NIMH Workgroup on Behavior Change, 2001

Common Components for Reducing HIV Risk among runaway & homeless youth (I)

Common Components for Reducing HIV Risk among runaway & homeless youth (II)

Generic, Stepped Care Interventions; heavy mobile emphasis • Automated Messaging & Monitoring • Peer Support (Muut) • Coaching

Progressing through Steps Stepped-Care for Youth Living with HIV

EBI Practice Elements Used by Coaches % of Utilization

Target Areas Discussed by Coaches % of Utilization

Our current approach is counter the prevailing scientific norms of EBI.

If you provide STABLE HOUSING, people remain housed & substance abuse & mental health disabilities are reduced.

Privatization of $47.5 billion dollar industry $32 billion special education $12-15 billion child welfare $ 3.5 billion juvenile justice

Thank You

30 Years – More homeless youth, But few other changes